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Aaron Carroll On Obamacare's First Year: You Have To Acknowledge How Much Of A Change There's Been

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"A year ago this week, the healthcare.gov website was in near meltdown. Both supporters and opponents of Obamacare were appalled at how badly the rollout of Obamacare was going. So, rather than get a birthday cake, we invited Dr. Aaron Carroll to stop by and give his assessment of how things have gone in the year since."

Interview highlights

Dr. Aaron Carroll: You have to acknowledge how much of a change there's been since last year to this year. I think even if you play back my appearances from the fall, I was very unhappy on about badly the rollout had occurred, how many techno-glitches there were. I'm pretty sure I was on record saying multiple times that if they don't fix this and soon, it's going to be a real problem. And they did. They fixed it to the point where enrollment was at, if not better than I think what they had hoped for in terms of the exchanges. This time around, you hope it goes more more smoothly. Most of the exchanges are already set up and running. The big trickiness to watch out for going forward are two things: One is that everybody has been concerned about what will happen in year two. Now that we've seen how much health care costs during year one, where there are going to to be more enormous rate increase in the exchanges, because everyone sort of undershot what they thought health care might cost, the opposite has sort of occurred. Kaiser Family Foundation just put out a report very recently which showed that in the fifteen markets they were following, on average, the benchmark plan upon which they base the subsidies actually went down. The law is going to cost much less than had been anticipated, because the premium is going to be less, therefore the subsidy is going to be less. Certainly this rate shock is not really appearing. That was everybody's big concern. However, the other thing that everybody has to be very much aware of is that it's still important to shop around for your insurance. Just because your plan last year was the cheapest or the one that looked best in terms of costs vs. benefits, your plan may have changed or may have gone away or may have had some other thing change so that it could have gone up in price where it's no longer the cheapest one. And although, the Affordable Care Act tried to make it simple for people to keep re-enrolling in their insurance plan, there's a real chance that that will not offer you the most cost-effective option, or even the most economical option, in what will be offered for the next year. So it is still very important for people to go back and shop around again and even change plans if they need to in order to get what works best for them. 

Lewis: Other than the signup, what about the whole first year of implementation? How has that gone in your opinion?

Carroll: I think, certainly given how badly it started, very well. They are beating expectations in terms of the number of signups. Everybody panicked that it was all going to be older, sicker people, which was going to drive up rates. That absolutely has not occurred. Rates, if anything, have been stable, if not decreasing for a lot of places. Many people were concerned that signups wouldn't occur at all. That certainly didn't happen. Medicaid expansion, while a number of states have chosen to opt out, there have been recent stories of states reconsidering, Pennsylvania and perhaps even Tennessee among them. Which again, is very much what we've talked about over the past year or two, with the history of how traditional Medicaid went into place, what is likely to occur even with the Medicaid expansion.